Varicose veins are swollen blood vessels which do not function efficiently. While they most frequently appear on the legs, they may also develop in the pelvic region, in the lower abdomen or around the genitals, thighs or buttocks. Patients with pelvic varicose veins, or pelvic congestion syndrome, may be asymptomatic. They may also experience troubling symptoms, primarily pain in the region. Women suffer more frequently with pelvic varicose veins, but men are also susceptible to the problem. Pelvic varicose veins may be invisible, particularly when the patient is lying down.
Causes of Pelvic Varicose Veins
Varicose veins form when vein walls weaken, known as venous insufficiency, and when valves within the vein deteriorate and allow blood to flow backward, known as venous reflux. Risk factors for pelvic varicose veins include:
- Family history of the disorder
- Repeated pregnancies
- Sedentary lifestyle
Symptoms of Pelvic Varicose Veins
Research has shown that as many as a third of all women suffer pelvic pain during their lifetime. When this pain is caused by pelvic congestion syndrome, it is often experienced as dull and aching, but may occasionally present as more acute. Such pain tends to be worse at the end of the day and is exacerbated by long periods of standing. Pain may be worse just before a menstrual period or during or after sexual intercourse. Women with this disorder may also experience one or more of the following symptoms:
- Enlarged uterus
- Thicker endometrium
- Ovarian changes
- Stress incontinence
- Back pain
- Vaginal discharge
- Severe menstrual pain or dysmenorrhea
- Abdominal bloating
- Mood swings
Diagnosis of Pelvic Varicose Veins
There are other causes of pelvic pain than varicose veins in the region. These causes, such as ovarian cancer, must be ruled out before a definitive diagnosis of pelvic congestion syndrome can be made. Since varicose veins in the pelvic region are not always visible even on sophisticated imaging devices, a Doppler ultrasound may be used. The most effective diagnostic test for pelvic varicose veins is usually a CT venogram using contrast dye. The dye is used so that the affected veins can be better visualized on X-ray.
Treatment of Pelvic Varicose Veins
If venography makes it clear that varicose veins exist in the pelvic region, they are removed through a process called embolization. Embolization, which is a minimally invasive procedure, may be performed one of two ways. In one, a metal coil is inserted into the diseased vein, often either the femoral vein or the ovarian vein, causing a clot to form and blocking blood flow. In the other, a sclerosant, or a solution which irritates the vein, is used. In either case, the affected vein slowly collapses and other, healthier veins to take over its circulatory role. Embolization is performed while the patient is under local anesthesia with intravenous sedation. The procedure is performed by an interventional radiologist.
Embolization is necessary in the treatment of varicose veins in the pelvic region since these veins are deep within the body and cannot be easily reached surgically. They are also not available for laser treatment since the heat generated by the laser would put adjacent organs at risk.
Risks of Pelvic Varicose Veins
Although widely considered a very safe and effective form of treatment, ovarian vein embolization does carry some risks. These risks, while rare, may include:
- Blood vessel damage
- Bleeding at the treatment site
- Allergic reaction to the contrast dyes
Recovery from Treatment of Pelvic Varicose Veins
A large majority of patients experience significant pain reduction after the embolization procedure. This procedure may be done outpatient, but sometimes requires an overnight admission to the hospital for pain management. Once the patient is released from the hospital, some days will be spent in recovery. The patient will be prescribed pain medication for the first few days. After that time, over-the-counter medications should be all that is needed. In rare instances, the patient may need to have a second embolization procedure.